Behavioral interventions to improve sleep outcomes in people with multiple sclerosis: A systematic review

Objective To determine effective behavioral interventions to improve sleep in people with MS. Methods Systematic review following PRISMA guidelines. Data Sources Literature searches were performed in December 2021 in Ovid MEDLINE, CINAHL, and Web of Science along with hand searching for grey literature and cited references. Out of the 837 search results, 830 unique references were reviewed after duplicates were removed. Study Selection Four reviewers independently reviewed titles and abstracts (two reviewers for each article), and a fifth reviewer resolved discrepancies. The full-text articles (n = 81) were reviewed independently by four reviewers (two for each article) for eligibility, and consensus for inclusion was achieved by a fifth reviewer as needed. Thirty-seven articles were determined eligible for inclusion. Data Extraction Four reviewers extracted relevant data from each study (two reviewers for each article) using a standard data-extraction table. Consensus was achieved for completeness and accuracy of the data extraction table by a fifth reviewer. Four reviewers (two reviewers for each article) conducted a quality appraisal of each article to assess the risk for bias and quality of the articles and consensus was achieved by a fifth reviewer as needed. Data Synthesis Descriptions were used to describe types of interventions, sleep outcomes, results, and key components across interventions. Conclusions The variability in the intervention types, intervention dose, outcomes used, training/expertise of interventionist, specific sample included, and quality of the study made it difficult to compare and synthesize results. Overall, the CBT-I, CBT/psychotherapy, and education/self-management support interventions reported positive improvements in sleep outcomes. The quality appraisal scores ranged from low to high quality indicating potential for bias. Further research is necessary to demonstrate efficacy of most of the interventions.